HomeMy WebLinkAboutPERMIT RENEWAL REQUESTPLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL34982
(772) 462-1553 Fax (772) 462-1578 `SCgNN��
BY
PERMIT RENEWAL REQUEST St, Lucia rnm7tV
PERMIT NUMBER: 16/ Z- 07-(90 ADDRESS: N 1 — qK NYL ?t' RA)AM-Vj[j( 7- 611A0
I, /41ilau-&Z e - /L, am requesting that the above permit be renewed. I
understand that I must;CIi� schedule and pass all required inspections for the permit to be fmaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a .
passing inspection during any six month period during the renewal period.
Justification
Print Name
STATE OF FLORID- `e • o COUNTY OF ';�A '
ACKNOWLEDGED BEFORE ME THIS i ck DAY OF�—� . 20—A2,
By qyvWHO IS PERSONALLY KNOWN TOME OR
HAS PROVIDED AS IDENTIFICATION.
ST4qE OF FLORIDA, Coun oI. h „wr LASHAHNA INGRAM
+
P Notary Public - state of Fforlda
i P OF NOTARY SEAL •`_ My -Comm. Expires Dee 20, 2018
•„o Commisslan 7f FF 177249
' P,„„`• ° ?cnde7:hrough National Notary Allah
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get % of open inspections)
Percentage:
_Original_permit fee: x % open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee) x .65=$113.75 (renewal fee)
Revised 7212614